Stephen V. Faraone

SeminarAttention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a disorder of inattention, impulsivity, and hyperactivity that affects 8-12% of children worldwide. Although the rate of ADHD falls with age, at least half of children with the disorder will have impairing symptoms in adulthood. Twin, adoption, and molecular genetic studies show ADHD to be highly heritable, and other findings have recorded obstetric complications and psychosocial adversity as predisposing risk factors. Converging evidence from animal and human studies implicates the dysregulation of frontal-subcortical-cerebellar catecholaminergic circuits in the pathophysiology of ADHD, and molecular imaging studies suggest that abnormalities of the dopamine transporter lead to impaired neurotransmission. Studies during the past decade have shown the safety and effectiveness of new non-stimulant drugs and long-acting formulations of methylphenidate and amfetamine. Other investigations have also clarified the appropriate role of targeted psychosocial treatments in the context of ongoing pharmacotherapy.

Langwirksame Medikamente zur Behandlung der hyperkinetischen St?rungen. Teil 1: ?bersicht und Empfehlungen

Langwirksame Medikamente zur Behandlung der hyperkinetischen St?rungen. Teil 1: ?bersicht und EmpfehlungenA panel of experts from several European countries has accomplished a systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorders, on the basis of which practical recommendations for the application of these medications have been developed. The current article outlines results of this analysis, comparing the effect sizes and numbers-needed to-treat for extended-release stimulant preparations and atomoxetine (ATX). It is concluded (1) that long-acting preparations should be licensed and used. (2) However, they should not completely replace short-acting medications, in view of costs as well as the greater flexibility of dosing. Individual choices of therapy are necessary. (3) Both ATX and retarded-release stimulants should be available.Zusammenfassung: Ein Expertengremium aus mehreren europaischen Landern hat samtliche verfugbaren veroffentlichten und unveroffentlichten Studienergebnisse zum Einsatz von langwirksamen Medikamenten bei ADHS und hyperkinetischer Storung analysiert und auf dieser Grundlage Empfehlungen zur praktischen Anwendung dieser Arzneimittel entwickelt: Auf der Grundlage der Analyse wurde gefolgert: (1) Langwirksame Praparate sollten zugelassen sein und eingesetzt werden; (2) Sie sollen kurzwirksame Arzneimittel (aus Kostengrunden und wegen der hoheren Flexibilitat der Dosierung) nicht vollstandig ersetzen. Individuelle Therapieoptionen sind erforderlich. (3) Sowohl ATX als auch Stimulanzien mit retardierter Freisetzung sollten zur Verfugung stehen. Zusatzlich werden ausfuhrliche Empfehlungen gegeben, nach welchen Kriterien ein spezifisches Praparat fur den individuellen Patienten ausgewahlt werden sollte.A panel of experts from several European countries has accomplished a systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorder. Based on this analysis detailed recommendations about the use of these drugs in practice have been developed: (1) Long-acting preparations should be licensed and used; (2) They should not completely replace short-acting drugs (which will be the initial treatment for many children in view of cost and the greater flexibility of dosing). Individual clinical choices are necessary. (3) Both ATX and extended-release stimulants should be available. In addition, detailed recommendations will be made with regard to the criteria to be applied in choosing a preparation for the individual patient.

Langwirksame Medikamente zur Behandlung der hyperkinetischen Störungen. Teil 2: Ein quantitativer Vergleich der langwirksamen Präparate

A panel of experts from several European countries has accomplished a systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorders, on the basis of which practical recommendations for the application of these medications have been developed. The current article outlines results of this analysis, comparing the effect sizes and numbers-needed to-treat for extended-release stimulant preparations and atomoxetine (ATX). It is concluded (1) that long-acting preparations should be licensed and used. (2) However, they should not completely replace short-acting medications, in view of costs as well as the greater flexibility of dosing. Individual choices of therapy are necessary. (3) Both ATX and retarded-release stimulants should be available.Langwirksame Medikamente zur Behandlung der hyperkinetischen Storungen. Teil 2: Ein quantitativer Vergleich der langwirksamen Praparate